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OBJECTIVE: Which is superior, partial nephrectomy (PN) or radical nephrectomy (RN), for the treatment of complex renal tumours (RENAL or score ≥ 7)? METHODS: This systematic review and meta-analysis was conducted in accordance with the PRISMA statement. A systematic search of the literature published before November 2023 was conducted using Pubmed, Embase, Cochran, and Web of Science libraries. We included studies comparing perioperative and oncologic outcomes of partial nephrectomy and radical nephrectomy for complex renal tumors. RESULTS: A total of 2602 patients from six studies meeting the criteria were included. The PN group had a longer operative time, increased estimated blood loss, and major complications but a smaller reduction in renal function. There were no significant differences in complications, length of hospital stay, and blood transfusion. In terms of oncological outcomes, the PN group had longer OS, CSS, and no significant difference in RFS. CONCLUSIONS: For complex renal tumours, PN requires more operative time and has a higher chance of complications in the short term. However, in long-term follow-up, PN has a small decrease in renal function with longer OS and CSS.
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Neoplasias Renais , Nefrectomia , Humanos , Neoplasias Renais/cirurgia , Neoplasias Renais/patologia , Nefrectomia/métodos , Taxa de Sobrevida , Complicações Pós-Operatórias/etiologia , Duração da Cirurgia , Prognóstico , Tempo de Internação/estatística & dados numéricosRESUMO
OBJECTIVE: Comparing the safety and efficacy of single-port (SP) versus multi-port (MP) robotic-assisted techniques in urological surgeries. METHODS: A systematic review and cumulative meta-analysis was performed using PRISMA criteria for primary outcomes of interest, and quality assessment followed AMSTAR. Four databases were systematically searched: Embase, PubMed, The Cochrane Library, and Web of Science. The search time range is from database creation to December 2022. Stata16 was used for statistical analysis. RESULTS: There were 17 studies involving 5015 patients. In urological surgeries, single-port robotics had shorter length of stay (WMD = - 0.63, 95% Cl [- 1.06, - 0.21], P < 0.05), less estimated blood loss (WMD = - 19.56, 95% Cl [- 32.21, - 6.91], P < 0.05), less lymph node yields (WMD = - 3.35, 95% Cl [- 5.16, - 1.55], P < 0.05), less postoperative opioid use (WMD = - 5.86, 95% Cl [- 8.83, - 2.88], P < 0.05). There were no statistically significant differences in operative time, positive margins rate, overall complications rate, and major complications rate. CONCLUSION: Single-port robotics appears to have similar perioperative outcomes to multi-port robotics in urological surgery. In radical prostatectomy, single-port robotics has shown some advantages, but the specific suitability of single-port robots for urological surgical types needs to be further explored.
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Prostatectomia , Procedimentos Cirúrgicos Urológicos , Masculino , Humanos , Bases de Dados Factuais , Linfonodos , Duração da CirurgiaRESUMO
BACKGROUND: To compare the safety and clinical efficacy of Moses laser enucleation of the prostate (MoLEP) with those of holmium laser enucleation of the prostate (HoLEP) for treating benign prostatic hyperplasia (BPH). METHODS: We systematically searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang databases, and SinoMed databases. The retrieval period was from the establishment of the database to March 2022. Stata17.0 was used for calculations and statistical analyses. RESULTS: This study included 12 articles comprising 1160 patients for meta-analysis. Compared with those of the HoLEP group, the hemostasis time (weighted mean difference [WMD] = -4.66, 95% confidence interval [CI] [-6.47, -2.84], p < 0.001), enucleation time (WMD = -7.23, 95% CI [-10.67, -3.79], p < 0.001), operative time (WMD = -15.02, 95% CI [-20.50, -9.53], p< 0.001), length of hospital stay (WMD = -15.02, 95% CI [-20.50, -9.53], p< 0.001), intraoperative blood loss (WMD = -11.19, 95% CI [-12.94, -9.44], p< 0.001), and total postoperative complications rate (OR = 0.51, 95% CI [0.32, 0.81], p = 0.004) were shorter in the MoLEP group. Postoperative quality of life (WMD = 0.30, 95% CI [0.00, 0.59], p = 0.047) was lower in the HoLEP group, and there were no statistically significant differences in the International Prostate Symptom Score, postoperative maximum urinary flow rate, and postoperative residual urine (p > 0.05). CONCLUSION: MoLEP has more advantages than HoLEP in terms of safety, shorter operation time and hospital stay, and fewer complications. However, this conclusion needs to be verified with a larger sample size, longer follow-up time, and multicenter randomized controlled trial data.
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Hólmio , Lasers de Estado Sólido , Masculino , Humanos , Lasers de Estado Sólido/uso terapêutico , Próstata/cirurgia , Qualidade de Vida , Tecnologia , Estudos Multicêntricos como AssuntoRESUMO
BACKGROUND: For medical institutions without robotic equipment, it remains uncertain whether laparoscopic radical nephroureterectomy (LNU) can achieve results similar to those of robotic surgery for the treatment of upper tract urothelial carcinoma (UTUC). This meta-analysis aimed to compare the efficacy and safety of robot-assisted radical nephroureterectomy (RANU) with that of LNU using a large sample size of patients. METHODS: A systematic meta-analysis was performed using data (available to May 2022) acquired from multiple scientific databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, according to the protocols registered with PROSPERO (CRD42021264046), were followed to perform this cumulative analysis. RESULTS: Nine high-quality studies were included in this analysis, considering factors such as operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), positive surgical margins (PSM), and complications. Statistical indicators revealed no significant differences between the RANU and LNU groups in terms of OT (weighted mean difference [WMD] 29.41, 95% confidence interval [CI] -1.10 to 59.92; p = 0.22), EBL (WMD -55.30, 95% CI -171.14 to 60.54; p = 0.13), LOS (WMD -0.39, 95% CI -1.03 to 0.25; p = 0.12), PSM (odds ratio [OR] 1.22, 95% CI 0.44-3.36; p = 0.17], or complications (OR 0.91, 95% CI 0.49-1.69; p = 0.13). CONCLUSION: The meta-analysis showed that the perioperative and safety indicators of both RANU and LNU were similar and both showed favorable outcomes in UTUC treatment. However, some uncertainties remain in the implementation and selection of lymph nodes for dissection.
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Carcinoma de Células de Transição , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Neoplasias da Bexiga Urinária , Humanos , Nefroureterectomia/efeitos adversos , Carcinoma de Células de Transição/cirurgia , Carcinoma de Células de Transição/patologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Resultado do Tratamento , Laparoscopia/efeitos adversos , Laparoscopia/métodosRESUMO
Optical biosensor, which perceptively captures the variety of refractive index (RI) of the surrounding environment, has great potential applications in detecting property changes and types of analytes. However, the disequilibrium of light-matter interaction in different polarizations lead to the polarization-dependence and low sensitivity. Here, we propose a polarization-independent and ultrasensitive biosensor by introducing a one-dimensional topological photonic crystal (1D TPhC), where two N-period 1D photonic crystals (PhC1 and PhC2) with different topological invariants are designed for compressing the interaction region of the optical fields, and enhancing the interaction between the light and analyte. Since the strong light-matter interaction caused by the band-inversion is polarization-independent, the biosensor can obtain superior sensing performance both for TE and TM polarization modes. The sensitivity and Figure of Merit (FOM) of the designed biosensor are 1.5677×106 RIU-1 (1.3497 × 106 RIU-1) and 7.8387×1010 RIU-1deg-1 (4.4990×1010 RIU-1deg-1) for TM (TE) polarization mode, which performs two orders of magnitude enhancement compared with the reported biosensors. With the protection of the topological edge state, this biosensor has high tolerance to the thickness deviations and refractive index (RI) variations of the component materials, which can reduce the requirements on fabrication and working environment. It is anticipated that the proposed biosensor possesses excellent sensing performances, may have great potentials in environmental monitoring, medical detection, etc.
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Técnicas Biossensoriais , Fótons , Óptica e Fotônica , RefratometriaAssuntos
Carcinoma de Células de Transição , Neoplasias Renais , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Humanos , Nefroureterectomia , Carcinoma de Células de Transição/cirurgia , Carcinoma de Células de Transição/patologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias Ureterais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Renais/cirurgiaRESUMO
Objective: Assessing whether Mayo adhesive probability (MAP) levels affect perioperative outcomes after partial nephrectomy (PN). Methods: This systematic review and meta-analysis were conducted in accordance with the PRISMA statement. A systematic search of the literature published before February 1, 2023 was conducted using Pubmed, Embase, Cochran, and Web of Science libraries. We included all articles evaluating adherent perirenal fat by MAP during PN. Results: A total of 1807 patients from 7 studies meeting the criteria were included. In the high MAP group, the operation time was longer, and the estimated blood loss and postoperative complications were increased. There was no significant difference in positive surgical margin, warm ischemia time, and hospitalization time. Conclusions: As a simple and easy scoring method, MAP can predict the perioperative outcome of PN patients, especially when ≥3 is the boundary. However, more cohort studies are still needed to determine the optimal cutoff point of MAP.
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Neoplasias Renais , Humanos , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Rim/cirurgia , Isquemia Quente , Probabilidade , Resultado do Tratamento , Estudos RetrospectivosRESUMO
Artificial superhydrophobic surfaces hold significant potential in various domains, encompassing self-cleaning, droplet manipulation, microfluidics, and thermal management. Consequently, there is a burgeoning demand for cost-effective, mass-producible, and easily fabricated superhydrophobic surfaces for commercial and industrial applications. This research introduces an efficient, uncomplicated method for constructing hierarchical structures on hard substrates such as binderless tungsten carbide (WC) and glass substrates. The WC substrates were processed by using electrical discharge machining (EDM) with a magnetic-assisted self-assembly sheet electrode. The resultant surfaces comprised micropillars/microgrooves and diminutive craters formed by discharge and ablation, respectively. These surfaces exhibited superior hydrophobic properties, which can be attributed to the modified surface energy and surface texture construction. Our study indicates that a superhydrophobic surface can be achieved on a textured binderless WC. The maximum contact angle and minimum roll-off angle of the hierarchical structure induced by EDM with a magnetic-assisted self-assembly sheet electrode are about 158 and 5°, respectively. The advancing and receding angles are about 161° ± 2 and 157° ± 3, respectively, when the base is tilted at 3°. Furthermore, we have successfully replicated this superhydrophobic structured surface on glass substrates utilizing glass molding technology. This innovative approach to creating superhydrophobic surfaces on hard materials paves the way for the mass production of functional structures on other materials, such as metallic glass, titanium alloy, and mold steel. Most crucially, the proposed fabrication technique offers a straightforward, cost-effective route for creating functional surfaces, rendering it attractive for large-scale industrial production due to its considerable application prospects.
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OBJECTIVE: To compare the safety and effectiveness of minimally invasive surgery (MIS) with open inguinal lymph node dissection (O-ILND) in penile cancer. METHODS: We performed a systematic reviews and cumulative meta-analyses of primary results of interest according to PRISMA criteria, and quality assessment followed AMSTAR. The system searched five databases, including Zhiwang, Embase, PubMed, Cochrane Library and Web of Science. The search period ranged was from database creation until September 2023. The statistical analysis software used Stata16. RESULTS: A total of 16 studies, including 898 patients. Compared to O-ILND, MIS is superior in length of stay (WMD = -2.96, 95%CI [-4.38, -1.54], P < 0.05), drainage time (WMD = -3.24, 95%CI [-4.70, -1.78], P < 0.05) and estimated blood loss (WMD = -35.70, 95%CI [-46.27, -25.14], P < 0.05), while operation time, recurrence rate and 5-year overall survival rate are the same. The number of lymph nodes dissection between the two groups are not statistically significant. Subgroup analyses found that there are more lymph nodes dissection in robotic-assisted inguinal lymph nodes dissection (WMD = 0.50, 95%CI [0.20, 0.80], P < 0.05). The overall complication rate of MIS was lower (OR = 0.26, 95%CI [0.09, 0.70], P < 0.05). CONCLUSION: Minimally invasive inguinal lymph nodes dissection appears to be a better option for penile cancer cases. But more large samples and multicenter studies are needed to further confirm.
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RATIONALE AND OBJECTIVES: To compare perioperative and oncology outcomes of ablation and partial nephrectomy in small renal masses (SRMs). METHODS: We conduct this meta-analysis strictly according to the PRISMA standard, and the quality evaluation follows the AMSTAR standard. Four databases, Embase, PubMed, Cochrane Library, and Web of Science, were systematically searched. The search time range is from database creation to November 2023. Stata16 statistical software was used for statistical analysis. Weighted mean difference (WMD) represented continuity variables, odds ratio or relative risk (OR/RR) represented dichotomies variables, and 95% confidence intervals (95%CI) were calculated. RESULTS: A total of 27 studies, including 6030 patients. Results showed that patients undergoing partial nephrectomy were younger (WMD = -5.45 years, 95%CI [-7.44, -3.46], P < 0.05), had longer operation time (WMD = 64.91 min, 95%CI [44.47, 85.34], P < 0.05), had longer length of stay (WMD = 2.91 days, 95%CI [2.04, 3.78], P < 0.05), and had more estimated blood loss (WMD = 97.76 ml, 95%CI [69.48, 126.04]. P < 0.05), the overall complication rate was higher (OR = 1.84, 95%CI [1.48, 2.29], P < 0.05), the major complication rate was higher (OR = 1.98, 95%CI [1.36, 2.88], P < 0.05), and the recurrence rate was lower (OR = 0.32, 95%Cl [0.20, 0.50], P < 0.05). However, there were no differences between ablation and partial nephrectomy in cancer-specific survival (CSS) (HR = 2.07, 95%CI [0.61, 7.04], P > 0.05), overall survival (OS) (HR = 1.24, 95%CI [0.58, 2.65], P > 0.05), and recurrence-free survival (RFS) (HR = 2.68, 95%CI [0.91, 7.88], P > 0.05). CONCLUSION: Patients undergoing partial nephrectomy are younger, have longer operation time and length of stay, and have higher complication rate. However, there was no significant difference in CSS, OS, and RFS between partial nephrectomy and ablation, but more well-designed, high-quality studies are needed to confirm this.
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Zr-based bulk metallic glasses (BMGs) possess unique mechanical and biochemical properties, which have been widely noticed. Jet electrochemical machining (jet-ECM), characterized by a high-speed jet, is a non-contact subtractive method with a high resolution and a high material removal rate (MRR). Past work on the electropolishing of Zr-based BMGs has indicated the feasibility of the NaCl-Ethylene Glycol (EG) electrolyte. In this research, the jet-ECM of Zr-based BMGs in the NaCl-EG electrolyte was studied to explore the dissolving mechanisms and surface integrity according to the voltage, pulse-on time and effective voltage time. The diameter, depth and surface morphologies of dimples were evaluated. The results showed that using this alcohol-based electrolyte led to a desirable surface morphology. The diameter and depth of the dimples varied with the voltage and the effective voltage time in a significantly positive proportional manner. Additionally, cases based on multiple parameter sets exhibited different stray corrosion severity. Afterward, machining performance can be enhanced in the next stage by tuning machining parameters to obtain microscale dimples with better quality.
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OBJECTIVE: Comparison of the perioperative outcomes of laparoscopic retroperitoneal lymph node dissection (L-RPLND) and open retroperitoneal lymph node dissection (O-RPLND) for low-stage (stage I/II) testicular germ cell tumors. METHODS: The authors performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to PRISMA criteria, and the quality assessment of the included studies followed the AMSTAR guidelines. Four databases were searched, including Embase, PubMed, the Cochrane Library, and Web of Science. The search period was from the creation of each database to October 2022. The statistical analysis software uses Stata17. RESULTS: There were nine studies involving 579 patients. Compared with O-RPLND, L-RPLND was associated with shorter length of stay [weighted mean difference (WMD)=-3.99, 95% CI: -4.80 to -3.19, P <0.05], less estimated blood loss (WMD=-0.95, 95% CI: -1.35 to -0.54, P <0.05), shorter time to oral intake after surgery (WMD=-0.77, 95% CI: -1.50 to -0.03, P <0.05), and lower overall complications (odds ratio=0.58, 95% CI: 0.38-0.87, P <0.05). Subgroup analysis found that the complication rate of Clavien-Dindo grade II was lower in L-RPLND (odds ratio=0.24, 95% CI: 0.11-0.55, P <0.05). Interestingly, there was no statistically significant difference between the two groups in terms of operation time, lymph node yields, and recurrence rate during follow-up. CONCLUSION: L-RPLND is superior to O-RPLND and is worthy of clinical promotion.
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Laparoscopia , Neoplasias Embrionárias de Células Germinativas , Neoplasias Testiculares , Masculino , Humanos , Estudos Retrospectivos , Excisão de Linfonodo , Neoplasias Testiculares/cirurgia , Neoplasias Testiculares/patologia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Neoplasias Embrionárias de Células Germinativas/patologia , Laparoscopia/efeitos adversos , Espaço Retroperitoneal/cirurgia , Estadiamento de Neoplasias , Resultado do TratamentoRESUMO
OBJECTIVE: To compare the safety and efficacy of robotic-assisted retroperitoneal lymph node dissection (RA-RPLND) versus non-robotic retroperitoneal lymph node dissection in testicular cancer. METHODS: The statistical analysis software used Stata 17. The weighted mean difference (WMD) represents the continuous variable, and the dichotomous variable chooses the odds ratio, and calculates the 95% CI. This systematic review and cumulative meta-analysis was performed according to PRISMA criteria, and AMSTAR guidelines (assessing the methodological quality of systematic reviews). The Embase, PubMed, Cochrane Library, Web of Science, and Scopus databases were searched. The upper limit of the search time frame was February 2023, and no lower limit was set. RESULTS: Seven studies involving 862 patients. Compared with open retroperitoneal lymph node dissection, RA-RPLND appears to have a shorter length of stay [WMD=-1.21, 95% CI (-1.66, -0.76), P <0.05], less estimated blood loss [WMD=-0.69, 95% CI (-1.07, -0.32), P <0.05], and lower overall complications [odds ratio=0.45, 95% CI (0.28, 0.73), P <0.05]. RA-RPLND appears to have more lymph node yields than laparoscopic retroperitoneal lymph node dissection [WMD=5.73, 95% CI (1.06, 10.40), P <0.05]. However, robotic versus open/laparoscopic retroperitoneal lymph node dissection had similar results in operation time, lymph node positivity rate, recurrence during follow-up, and postoperative ejaculation disorders. CONCLUSION: RA-RPLND appears to be safe and effective for testicular cancer, but longer follow-up and more studies are needed to confirm this.
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Laparoscopia , Procedimentos Cirúrgicos Robóticos , Neoplasias Testiculares , Masculino , Humanos , Neoplasias Testiculares/cirurgia , Neoplasias Testiculares/patologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Excisão de Linfonodo/métodos , Resultado do Tratamento , Laparoscopia/métodosRESUMO
BACKGROUND: The effectiveness and safety of laparoscopic adrenalectomy (LA) under different routes for the treatment of large pheochromocytomas (PCCs) is unknown. MATERIALS AND METHODS: This meta-analysis and systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Three databases were systematically searched, including Medline, PubMed, and Web of Science. The time frame of the search was set from the creation of the database to October 2022. Perioperative outcomes were divided into two groups according to tumor size: SMALL group (≤6 cm in diameter), LARGE group (>6 cm in diameter). RESULTS: Eight studies including 600 patients were included. In the LA group, complications was comparable in both groups (SMALL group and LARGE group), and the LARGE group had longer operative time [OT weighted mean difference (WMD)=32.55; 95% CI: 11.17, 53.92; P <0.01], length of stay (LOS WMD=0.82; 95% CI: 0.19, 1.44; P <0.05), more estimated blood loss (EBL WMD=85.26; 95% CI: 20.71, 149.82; P <0.05), hypertension [odds ratio (OR)=3.99; 95% CI: 1.84, 8.65; P <0.01], hypotension (OR=1.84; 95% CI: 1.11, 3.05; P <0.05), and conversion (OR=5.60; 95% CI: 1.56, 20.13; P <0.01). In the transabdominal LA group, OT, LOS, EBL, complications, hypertension, and hypotension were the same in both groups. In the retroperitoneal LA group, complications and hypotension were the same in both groups, while the LARGE group had longer OT (WMD=52.07; 95% CI: 26.95, 77.20; P <0.01), LOS (WMD=0.51; 95% CI: 0.00, 1.01; P <0.05), more EBL (WMD=92.99; 95% CI: 27.70, 158.28; P <0.01) and higher rates of hypertension (OR=6.03; 95% CI: 1.95, 18.61; P <0.01). CONCLUSIONS: LA remains a safe and effective approach for large PCC. Transabdominal LA is superior to retroperitoneal LA.
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Neoplasias das Glândulas Suprarrenais , Hipertensão , Hipotensão , Laparoscopia , Feocromocitoma , Humanos , Laparoscopia/efeitos adversos , Adrenalectomia/efeitos adversos , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/cirurgia , Resultado do Tratamento , Tempo de InternaçãoRESUMO
BACKGROUND: This systematic review and meta-analysis compared the safety and effectiveness of minimally invasive adrenalectomy (MIA) with open adrenalectomy (OA) in patients with large adrenal tumors (≥5 cm). MATERIALS AND METHODS: We performed a systematic review and cumulative meta-analysis of the primary outcomes according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Five databases including Medline, PubMed, Cochrane Library, Scopus, and Web of Science were systematically searched. The time frame of the search was set from the creation of the database to March 2022. RESULTS: Ten studies including 898 patients were included. Compared to OA, MIA is superior for length of stay [LOS WMD = -3.52, 95% CI (-4.61, -2.43), P < 0.01], drainage time [DT WMD = -0.68, 95% CI (-1.27, -0.09), P < 0.05] and fasting time [FT WMD = -0.95, 95% CI (-1.35, -0.55), P < 0.01], estimated blood loss [EBL WMD = -314.22, 95% CI (-494.76, -133.69), P < 0.01] and transfusion [WMD = -416.73, 95% CI (-703.75, -129.72), P < 0.01], while operative time (OT) and complications are not statistically different. For pheochromocytoma, MIA remains superior for LOS [WMD = -3.10, 95% CI (-4.61, -1.60), P < 0.01] and EBL [WMD = -273.65, 95% CI (-457.44, -89.86), P < 0.01], while OT and complications are not significantly different. CONCLUSION: MIA offers advantages over OA in the management of large adrenal tumors, including in the case of a specific large adrenal tumor - large pheochromocytoma.
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Neoplasias das Glândulas Suprarrenais , Laparoscopia , Feocromocitoma , Adrenalectomia , Humanos , Tempo de Internação , Duração da Cirurgia , Resultado do TratamentoRESUMO
Objective: To evaluate and compare the efficacy and safety between an external stent and a Double J stent for pediatric Pyeloplasty. Methods: Through a systematical search of multiple scientific databases in July 2022, we performed a systematic review and meta-analysis of the primary outcomes of interest according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), whose protocol was registered with PROSPERO(CRD42021274087). Results: Eleven studies involving 1,758 patients were included. No significant differences were observed in operative time (MD: 2.26; 95% CI -9.62 to 14.14; P = 0.79), operative success rate (OR: 1.10; 95% CI 0.57 to 2.10; P = 0.780), length of hospital stay (MD: 0.65; 95% CI -0.04 to 1.34; P = 0.063), or complications (OR: 0.87; 95%CI 0.48 to 1.56; P = 0.630) between external stents and DJ stents in pediatric pyeloplasty. According to the subgroup analysis, we found the external stent group had a shorter operative time than the DJ stent group in terms of robot-assisted laparoscopic pyeloplasty (MD: -17.13; 95% CI -32.8 to -1.45; P = 0.032). Conclusions: There were no significant differences in operative time, operative success rate, length of hospital stay, or complications between external stents and DJ stents in pediatric pyeloplasty. The external stented procedure seemed to have less operative time when using robot-assisted laparoscopic pyeloplasty. However, due to the limitations of our analysis, more studies are still required to support our conclusion. Systematic review registration: This systematic review has been registered on PROSPERO, the registration ID is CRD42021274087.
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Objective: This meta-analysis aims to assess whether the prognostic nutritional index (PNI) score before treatment can be an independent biomarker of the prognosis of patients with upper tract urothelial carcinoma (UTUC). Materials and methods: We systematically search PubMed, Embase, Scopus database, and Cochrane Library, and the search time is up to April 2021. Use STATA 16.0 software for data processing and statistical analysis. Results: Six studies, including seven cohorts, were eventually included in our meta-analysis. The meta-analysis results showed that low PNI scores are associated with worse OS (HR: 1.92; 95% CI 1.60 to 2.30; P < 0.01), DFS/RFS/PFS (HR: 1.57; 95% CI 1.33 to 1.85; P < 0.01), and CSS/DSS (HR: 1.79; 95% CI 1.49 to 2.16; P < 0.01), which supported the PNI score as an independent prognostic biomarker for survival outcomes. The subgroup analysis and Begg's test showed that the results were stable. Conclusion: Based on current evidence, this meta-analysis proves that the PNI score of UTUC patients before treatment is an independent prognostic biomarker. It performs well on OS, DFS/RFS/PFS, and CSS/DSS. This conclusion needs to be verified by a prospective cohort study with larger sample size and a more rigorous design. Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022338503], identifier [CRD42022338503].
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We performed a meta-analysis to compare the safety and effectiveness of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in treating nephrolithiasis ≥ 2 cm in patients with solitary kidneys. This systematic review was registered on PROSPERO (registration ID: CRD42021270519). The search time was set from the establishment of the databases until April 30, 2021. A systematic search was performed in the PubMed, MEDLINE, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Cochrane Library, and Embase databases. Stata 16 was used to perform the statistical analysis of the extracted data. After screening using strict inclusion and exclusion criteria, five studies with a total of 474 patients were included in the final meta-analysis. According to the literature quality assessment scale statistics, the five studies included were of high quality. The results of the meta-analysis showed that RIRS had lesser hemoglobin loss (HL), shorter length of hospital stay (LOS), lower initial (OR = 3.39, 95% CI [1.97, 5.83], P = 0.02) and final stone-free rates (OR = 2.24, 95% CI [1.24, 4.06], P = 0.03), but a higher incidence of grade III-IV complications (OR = 0.29, 95% CI [0.08, 0.97], P = 0.04) than PCNL. The difference between the two surgical methods was not statistically significant in terms of operation time (OT), grade I-II complication rate, and total complication rate. For nephrolithiasis ≥ 2 cm in patients with a solitary kidney, RIRS has the advantage of less HL and shorter LOS, while PCNL benefits from its higher SFR (both initial and final). Both RIRS and PCNL are effective treatments for nephrolithiasis in patients with a solitary kidney, and clinicians should choose the most appropriate option to achieve the best treatment outcome, taking into account the patient's underlying conditions and medical conditions.
Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Rim Único , Humanos , Nefrolitotomia Percutânea/efeitos adversos , Cálculos Renais/cirurgia , Duração da Cirurgia , Rim/cirurgiaRESUMO
OBJECTIVE: To compare the safety and effectiveness of robot-assisted adrenalectomy (RA) and laparoscopic adrenalectomy (LA). METHODS: We performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Guidelines. Five databases, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science, were systematically searched. The search timeframe was set from the creation of the database to December 2021. RESULTS: There were 26 studies including 2985 patients. Our study found that the robotic technique was superior to conventional laparoscopy for estimated blood loss (WMD = -18.25, 95% CI [-27.85, -8.65], P < 0.01), length of stay (WMD = -0.45, 95% CI [-0.57, -0.33], P < 0.01), and conversion to open (OR = 0.31, 95% CI [0.12, 0.78], P = 0.01), while complications and readmissions were comparable. Interestingly, there was no difference in operative time between the two surgical modalities, but subgroup analysis found that the retroperitoneal route robotic technique took longer (WMD = 14.64, 95% CI [0.04, 29.24], P < 0.05), whereas the study of the mixed surgical modality (RA versus LA with mixed transabdominal and retroperitoneal surgical routes) found that the robot required less time (WMD = -12.29, 95% CI [-22.86, -1.72], P < 0.05). For pheochromocytoma, RA was superior to LA in terms of length of stay (WMD = -0.49, 95% CI [-0.83, -0.15], P < 0.01), with no difference in other indicators. CONCLUSION: robotic-assisted adrenalectomy is a superior technique to conventional laparoscopy in managing adrenal tumors, even in the case of a specific adrenal tumor - pheochromocytoma.